It seems like the only thing I do these days is scroll through social media in a desperate attempt to gain information. My phone has called me out on my screen time more than once, and I just continue to ignore it. You're probably in the same boat — stuck at home, scrolling deeper and deeper into a hole of conspiracy theories and possible "back to normalcy" dates, hungry for information.
While we know that the news is not our mental health's friend these days, getting reliable information is helpful and necessary.
While the rest of us are home on our phones, healthcare workers are on the coronavirus (COVID-19) front line every single day. They see what we read snippets of, quickly gaining the perspective that we couldn't fathom. That's why we're going to the root of the information — these healthcare workers who put their own safety at risk every single day.
Today, I sat down (virtually) with Brianna Hansen, a nurse working in Portland, Oregon.
How long have you been a nurse?
I've been a nurse for two years.
What department do you work in?
My department is a hybrid unit. It is both an intermediate care unit (IMCU) and intensive care unit (ICU). Intermediate care is the step down from the ICU, and I primarily work in the IMCU side of the unit.
What is your hospital's procedure in regard to COVID-19 patient care?
My hospital is part of a large chain of hospitals in the Portland area. In February, the entire hospital system created an emergency management team to develop a plan of how we were going to address a potential surge of COVID patients. The hospital that I work at also devised an emergency management team that meets every day to address new issues that come up on a day to day basis.
When a suspected COVID patient comes into my hospital, they are immediately put in an isolation room. The patient is assessed by the ER nurse and physician and they determine if they are unstable enough to be admitted or if they can isolate themselves at home without a risk of them further deteriorating. The emergency department nurses wear protective equipment (gloves, gown, feet booties, a hair cover, and a standard surgical mask with eye protection). Once the ED decides they need to be admitted, based on their acuity level (how sick they are), the patient is admitted to one of our three designated inpatient COVID units that have been set up.
We have a COVID medical floor for people requiring a little bit of extra support like oxygen, IV antibiotics, fluids, but are relatively stable. We also have a COVID IMCU unit for patients who potentially have a higher risk of deterioration and are requiring increased monitoring, Finally, we have a COVID ICU unit for our patients that are requiring vasoactive medications, intubation and mechanical ventilation, and extremely close monitoring of their vital signs.
In my nursing practice, I have seen a significant change in the sense that we try to limit our time in the patients' rooms as much as possible while still providing them with the care that they need. Since personal protective equipment (PPE) is on short supply we have to be very intentional when we go into a patient's room to make sure that we "cluster" their care, or do as much as we can at once to limit the amount of exposure and PPE. We have moved all of our IV poles outside of the patient's rooms — something we have NEVER done before — allowing us to run all the normal medications for these patients without having to enter and exit the room, which decreases exposure and conserves PPE without causing any change in the quality of care the patient is getting.
What is the protocol if you (or another nurse) shows signs of infection?
There are nurses who work at all of our hospital entrances that check our temperature and hand us a mask to wear as soon as we come to work. If we notice symptoms, we have to call employee health and they assess if we need to be tested. If they believe we should be tested, then we have a drive-up, employee-only testing center in Portland. It typically takes three to five business days to get the results back. If they are negative we return to work, and if they are positive then we are off for 14 days.
Do you have enough PPE?
So far, we have had enough PPE. Our hospital system has created a tier system based on our PPE need and how conservative we need to be with it at this time. I know most places have been concerned about a lack of N-95 masks, but my hospital has been using a different form of airborne precautions. We use a PAPR, which is a fancy helmet that has a face shield on it that closes around my chin. It has a HEPA filter, a battery pack, and a fan that uses positive pressure to push any airborne pathogens away from me. It is 99 percent effective for protection, whereas an N-95 is 95 percent protection against pathogens. I feel very safe wearing it, but we are reusing the shields for the helmet, which are supposed to be disposable. We were on a critical shortage for a while, but a dental equipment company in the local area developed a prototype and created a face shield for us that we are now using in the hospital.
What is the biggest change your day-to-day has faced because of COVID-19?
The biggest challenge I have faced because of COVID-19 is the emotional and mental stress everyone is under. The patients that I take care of are extremely sick, but they are also extremely scared. This puts an entirely new layer of emotional stress on the staff and the patients.
I have had several of the patients ask me, "Are people getting better from this?" and "Am I going to die?" The hardest part for me is that I don't have a good answer for them. Every patient is different, and sometimes I have a strong feeling that the patient is not going to make it but as a nurse, it's not in my scope of practice to have that conversation with them. In my head, I know that they probably only have a few days left to live and they probably won't be able to say goodbye to their families and spouses in person, but I try to stay as optimistic and positive with them as possible to give them the best chance of recovery as I can.
When I step into work I feel a sense of dread and apprehension because I just don't know what I'm are going to be walking into. The sense of dread, fear, and loss of patients with visitor bans has been the hardest thing to face with COVID-19.
Describe your hospital's atmosphere.
There is a general sense of unease throughout the hospital. In my hospital, we have not been overrun by patients, but it has actually been the opposite. The only patients we have are COVID patients. The normal types of patients that we see have not been coming in due to this virus. It feels like there is a slight eeriness within the hospital because it's been quiet — except for the COVID units. There is just a sense of dread for what could be coming when we look at what is happening in New York, New Jersey, Italy, and Spain, which has caused healthcare workers to speak out and highly encourage social distancing so that we can keep the hospitals quiet and hopefully save the lives of those that are high risk.
How do you feel about the national news coverage of COVID-19? Accurate? Downplaying the situation?
I think the national news coverage has been fairly accurate. I also think that the news doesn't need to be constantly covering COVID — there is a lot of fear that has been created by the constant stream of information. It's nice to hear about the positive things that are happening in the community, not just the COVID reports 24-7.
What is one thing you wish you could tell the country about COVID-19?
The one thing I wish I could tell the country about COVID-19 is that it is a dangerous virus, but we are an innovative country that has a heart that cares about one another — we can get through this if we do the right things. We have to stay on course with social distancing and follow the guidelines that our government is putting into place right now or else we will have another wave of COVID. COVID may not affect us all directly (especially young people) but it can be catastrophic for our elderly, our cancer patients, and our immunocompromised who are already fighting to stay healthy and live a normal life on a regular day. The least we can do is stay inside, stay positive, and support and protect one another… from a distance.
How is your personal life impacted by COVID-19?
My personal life has definitely been affected by COVID. My mom actually came down with COVID-19, probably due to exposure either from myself or from my dad. My dad is a firefighter and paramedic so we aren't sure which one of us gave it to her since neither of us had symptoms.
This really opened my eyes to how contagious it is and how I could have easily been an asymptomatic carrier. I feel like I'm carrying some guilt because I'm worried I exposed patients without even realizing that I had it. I received a nasal swab test for it and I tested negative, but I'm unsure if I had already recovered from it by the time I was swabbed. My mom handled the virus like a champ. She was down for about two weeks and she stated that "days eight to 10 were the worst." She felt short of breath and was worried that she was getting pneumonia. She is about a month out since she came down from the virus and is mostly back to normal but still struggles with fatigue. She said that the fatigue was one of the worst symptoms and one that has lingered on for her even past the 14-day mark where you are cleared to come out of quarantine.
Are there any stories of hope that you can share with us?
I feel like the story of hope that I can share with you guys actually comes from my mom's story. She can say that she had — and beat — COVID-19 and honestly, she kicked its butt. She was a champ throughout the whole thing and stayed positive the entire time she was sick. She did absolutely everything she could at home to fight the virus by taking Mucinex, Zinc, vitamin C, and multivitamins to give her immune system a fighting chance. She got up and moved, even when she didn't feel like it and practiced coughing and deep breathing as much as possible to keep things from building up in her chest. She rested, she prayed (we all prayed), and we didn't watch the news because it was too scary to watch when it hits that close to home. She came out successful on the other side without having to go into the ER at all.
(Disclaimer: these are just the things she did at home that worked for her. This is NOT saying that this will work for everyone.)
I think her story inspires hope because getting this virus does not mean it is a death sentence. Yes, it ABSOLUTELY should be taken seriously (believe me, I've seen the intubated prone patients who are not doing well), but there is hope for those who get it and I think our world will recover from this.
What advice can you give us for staying as healthy as possible?
The advice that I can give is what I'm trying to do to stay healthy. My tips would be to get plenty of sleep, take a multivitamin, take vitamin C, limit your trips to the grocery store, stay positive, and most of all WASH YOUR DANG HANDS. I started running (and walking) again because I need a release for the stress that I have been feeling, and I highly encourage everyone to get up and move at least a little bit once a day.
I know we all want to drink a bottle of wine a day because we are bored at home and are feeling a lot of emotions with this virus going around, but the best things we can do is try to stay active, limit stress and the news, and stay positive. This isn't forever, and we will get through this. And again, PLEASE wash your hands.
What can citizens in your area do to help healthcare workers fight COVID-19?
The best thing that citizens can do to help us is to social distance. I'm not saying you have to stay locked in your house 24/7, but limit your trips out, go for walks in your neighborhood, and have FaceTime happy hour instead of meeting in-person. The better we are at distancing, the sooner we will get out of this thing — the best thing is to stay home.
If you have any medical supplies like gloves, gowns, masks, or face shields please donate to your local hospital too because I know they would LOVE to have them for the staff so we can protect ourselves and help you when you get sick.
If you are a healthcare professional interested in sharing your story, please email firstname.lastname@example.org.
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